Old TB

Question 1

Old tuberculosis

Answer 1

Please examine this man’s respiratory system.

Question 2

Clinical signs

Answer 2

• Chest deformity and absent ribs; thoracoplasty scar
• Tracheal deviation towards the side of the fibrosis (traction)
• Reduced expansion
• Dull percussion but present tactile vocal fremitus
• Crackles and bronchial breathing

Question 3

Historical techniques for TB

Answer 3

• Plombage: insertion of polystyrene balls into the thoracic cavity
• Phrenic nerve crush: diaphragm paralysis
• Thoracoplasty: rib removal; lung not resected
• Apical lobectomy
• Recurrent medical pneumothoraces
• Streptomycin was introduced in the 1950s. It was the first drug shown to be beneficial in a randomized controlled trial

Question 4

Serious side effects of TB drugs

Answer 4

• Isoniazid: Peripheral neuropathy (Rx Pyridoxine) and hepatitis
• Rifampicin: Hepatitis and increased contraceptive pill metabolism
• Ethambutol: Retro‐bulbar neuritis and hepatitis
• Pyrazinamide: Hepatitis

Question 5

Precautions before treating TB

Answer 5

Prior to treating TB, check baseline liver function tests and visual acuity. Tell the patient the following:
1. Look at the whites of your eyes every morning. If yellow, stop the tablets and ring the TB nurse that morning.
2. Notice colours – if red becomes less bright than you expect ring the TB nurse that day.
3. You may develop tingling in your toes – continue with the tablets but tell the doctor at your next clinic visit.
4. Your secretions will turn orange/red. This is because of a dye in one of the tablets. If you wear contact lenses they will become permanently stained and should not be worn.
5. If you are on the OCP, it may fail. Use barrier contraception.

Question 6

Causes of apical fibrosis

Answer 6

‘TRASHE’
* TB
* Radiation
* Ankylosing spondylitis/ABPA
* Sarcoidosis
* Histoplasmosis/Histiocytosis X
* Extrinsic allergic alveolitis (now referred to as hypersensitivity pneumonitis)